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Original document included as part of Healthy Futures: Improving Health Outcomes for Young Children Medication Administration Curriculum. Copyright © 2009 American Academy of Pediatrics. All Rights Reserved.

The American Academy of Pediatrics does not review or endorse any modifications made to this document and in no event shall the AAP be liable for any such changes.

Medication Administration Curriculum - Module 1

Curriculum Objectives

1. Identify different types of medication, why medication

is given, and how it is given

2. Improve medication storage, preparation, and

administration techniques

3. Support good documentation of medication

administration

4. Recognize and respond to adverse reactions to

medication

5. Develop appropriate policies about medication

administration and implement them

Online Modules Overview

Module 1

• Reasons to Give Medication

• Rules and Regulations

• Shared responsibility of parents, caregivers, and

health care providers

• Types of medication

Module 2

• Documentation Forms

• Program Specific Policies and Procedures

• Confidentiality

• Receiving, storing, and disposing of medications


Disclaimer

• This curriculum provides education for personnel in the child care

setting who give medication to children but are not licensed

health care professionals

• It is not a substitute for written policy and professional medical

guidance

• It is not certification of competency

• Actual care must be based on the child’s clinical presentation, the

health care professional’s orders, parental guidance, personnel

experience and training, and facility policy

• Each program must review state laws, regulations, and

resources, and adapt accordingly


What Is Covered in This Workshop

• Typical and routine medications for short-term use

• Medications taken on a regular basis for chronic health

conditions

• Emergency medications


What Is Not Covered in

This Workshop

• Special medications like injectable or rectal medication

• Medication Management for children for children with

special or complex medical needs

These are important topics that are beyond the scope

of today’s program


Introduction: most common errors

5 Rights

Identifying “as needed” conditions

Universal/standard precautions

Preparing to administer medication

Medication administration

procedure

Communicating with the child

Overview How to Administer Medications

• 5 Rights

• Identifying as needed symptoms

• Application of Universal Precautions

• Preparing to Administer Medications

• Medication Administration procedures

• Communicating with the child


The “5 Rights”

• Right child

• Right medication

• Right dose

• Right time

• Right route


Right Child

• Check the name on the medication label and the

child’s name

• If any question arises, check a second identifier such

as date of birth

• Consider putting the child’s photo on the medication

forms


Right Medication

• Read the label to make sure you have the correct

medication

• Check to see:

– Medication is in the original labeled container

– Expiration date is not exceeded

• Especially important for children who are taking more

than 1 medication


Right Dose

• Check dose on label and authorization form

• Make sure the Dr.’s order is the most recent one.

• Use proper measuring device

• Check measuring device carefully


Right Time

• Check the permission form to match the time with

the label

• Check that medication is being given within 30

minutes before or after prescribed time

• Look at the clock and note the time

• The right time includes both time and date

• In an emergency, “now” is the right time to give

medication


Right Route

• Check the label and Authorization to Give Medicine

form

• How is the medication to be given?( By mouth,


“As Needed” Conditions

• Some medication, such as emergency medication, only

need to be given “as needed”

• Health care professionals and other prescribers should not

write “as needed” or “prn” without more specific instructions

– Example of acceptable, specific instructions: albuterol – 2 puffs as

needed for wheezing, increased cough, or breathing difficulty

• OTC medication for pain and fever should be kept to a

minimum and should be as specific as possible

• The order should state the maximum number of times the

dose can be repeated before seeking further medical care


Standard Precautions in Child Care Settings

Standard Precautions

• The term for the infection control measures that all

health and child care providers should follow in order

to protect themselves from infectious diseases and to

prevent the spread of infectious diseases to those in

their care

• Sometimes called universal precautions


Standard Precautions in Child Care Settings

What Do They Consist Of?

• Handwashing – Handwashing with soap and water should be done before medication

administration

• Disposable gloves

– Appropriate for applying diaper creams

– Topical ointments

– Eye drops

– Nose drops

( Any time there is exposure to open cuts or body fluids)


Medication Administration Procedure:

Prepare the Medication

• Find appropriate measuring device

• Measure the amount on the label

• Change the form of the medication ONLY if label

states for you to do so:

– Crushed or powdered medication

– Sprinkles

– Mix with food


Medication and Food

• It is usually best not to mix medication with food, but it

may be necessary

• Ask the prescriber or pharmacist before mixing

medication with food or liquid

• If medication is mixed with food or liquid, ALL of it

must be taken

• Give the child something to drink immediately

afterward to help with the taste



Prepare the Child

• Communicate with the child

• Explain the procedure to the child

– Never call medication “candy”

• Wash the child’s hands, if appropriate

• Position the child


Prepare the Child: Infants

• Support the infant’s head

• Hold the baby semi-upright

– An infant seat may be used

• Keep the infant’s arms and hands away from her face

• Gently press the chin to open the mouth

• Rock the baby before and after

• Syringe or dropper:

– Position on one side of the mouth along the gum

– Squirt slowly to allow time to swallow

• Special dosing nipples work best when the baby is hungry

• Give oral medication before feeding unless instructed otherwise


Prepare the Child: Toddlers

• Ask parents what techniques they use

• Give toddlers some control, like sitting or standing, but

do not give veto power over taking the medication

• Be honest about bad taste and allow the child to drink

afterwards

• Use age-appropriate language to explain what you are

doing

• Maintain an attitude that you expect cooperation

• Thank the child for their cooperation and praise them


Prepare the Child: Older Children

• Explain why we take medication and why they help us

to get better

• Use the opportunity to teach about time, body parts,

health, and illness

• Involving the child in the process helps to prepare him

to take his own medication as he gets older

• Books that talk about medication are helpful to read

with the child


Medication Administration Procedure

• Check 5 rights: child, medication, dose, time, and

route

– Note any special instructions

• Take the medication from the container

– Prepare the medication

• Check the label again

• Give the medication

– Never give more or less, accuracy is very important



Finishing Up

• Praise the child

• Check the label again

• Return the medication to storage immediately

– Never leave medication unattended

• Record the medication, date, time, dose, route, and

your signature on the Medication Log

• Clean the measuring device

• Wash your hands

• Observe the child for side effects


After Giving Medication

• Allow the child the opportunity to express his or her

feelings

• Acknowledge that some medication is difficult to take

• Encourage the child that next time will be easier

• Offer to spend time with the child


Oral Medication Video:

How to Give Oral Medication

Click to play video

Link to this video:

http://www.healthychild

care.org/InstructorsMan

ual.html

http://www.healthychildcare.org/InstructorsManual.html




Measuring Oral Medication

• Oral Measuring Devices

– Dropper

– Syringes: ½ tsp or less is most accurately measured with

syringe or similar device

– Dosing spoon

– Medication cup

• No kitchen teaspoons!


Topical Medication

• Skin creams, ointments, patches

• Eye drops, ointments

• Ear drops

• Use gloves to administer topical medication.

• Gather needed equipment (medication, applicator,

dressing, tissues, etc).


Topical Medication Video:

How to Give Topical Medication

Click to play video

Link to this video:



ual.html






How to Give Eye Drops

Click to play video

Link to this video:



ual.html






How to Give Ear Drops

Click to play video

Link to this video:



ual.html





Group Activity:

Receiving Medication, Preparing and

Administering, and Documenting Medication

Nick

Nick is 15-months-old and has an ear infection. Nick

needs a noon time dose of amoxicillin suspension for

this week and part of next week.

• Receive Medication for Nick

• List the steps to prepare to give medication to Nick

• Give the medication to Nick

• Document


Inhaled Medication

• Nasal sprays and drops

• Metered dose inhalers and nebulizers

How to Handle an Asthma Episode

1. Follow the asthma Plan

2. Call 911 if severe and contact

parent/guardian.

3. Administer quick-relief medicine

4. If medicine is not available, call 911.

http://www.nhlbi.nih.gov/health/pro

f/lung/asthma/basics_schools/

http://www.nhlbi.nih.gov/health/prof/lung/asthma/basics_schools/

http://www.nhlbi.nih.gov/health/prof/lung/asthma/basics_schools/

Vermont Asthma Action Plan

Caring for a Child with Asthma

Connecticut Medication Administration Training 2011

http://www.ucsfchildcarehealth.org/video/asthma/EN_Training_for_Providers.wmv



What is Anaphylaxis?

Allergic Reactions

• May involve many different types of symptoms

• Are difficult to predict

• Skin disturbances are the most common

• May be mild (redness of skin, itching) http://www.healthychildcare.org/InstructorsManual.html

An allergic emergency

a severe allergic reaction that can occur quickly

(as fast as within a couple of minutes) and

may be life threatening.” http://www.epipen.com/allergicemergencies/allergic-emergency

VIDEO:http://www.aaaai.org/conditions-and-treatments/videos/allergy-videos/what-

are-the-symptoms-of-anaphylaxis.aspx


http://www.epipen.com/allergicemergencies/allergic-emergency



http://www.aaaai.org/conditions-and-treatments/videos/allergy-videos/what-are-the-symptoms-of-anaphylaxis.aspx

















ANAPHYLAXIS VIDEO

http://www.youtube.com/watch?v=TTcL7u05aUU

http://www.youtube.com/watch?v=TTcL7u05aUU

Who is at Risk for Anaphylaxis ?

Anyone who has had:

• a prior anaphylactic reaction.

• a prior mild reaction to an allergen, a severe reaction

may be preceded by a less serious one.

An exposure to certain allergens (triggers) such as

• food (eg, peanuts, tree nuts, fish, shellfish, eggs, and

milk)

• stinging or biting insects (eg, bees, ants, and ticks)

• latex,

• medications (eg, penicillin) for those who are allergic


SIGNS OF AN ALLERGIC REACTION

• MOUTH itching & swelling of the lips, tongue, or mouth

• THROAT* itching and/or a sense of tightness in the

throat, hoarseness, and hacking cough

• SKIN hives, itchy rash, and/or swelling about the face

or extremities

• GUT nausea, abdominal cramps, vomiting, and/or

diarrhea

• LUNG shortness of breath, repetitive coughing, and/or

wheezing

• HEART* thready pulse, passing out

Emergency Health Care Plan

Every child at risk for an allergic reaction should have a

detailed treatment plan to be implemented in the event

of an allergic reaction including:

• Medication names, doses, and methods of

administration

• Specific symptoms requiring administration of one or

more medications

• Emergency contacts to call after administering

emergency medications and calling 911


http://healthvermont.gov/local/school/documents/SP03_allergies.pdf




How to Use and Epi Pen

• http://www.epipen.com/how-to-use-epipen

( video link)

http://www.epipen.com/how-to-use-epipen









How to Administer EpiPen®

• EpiPen® may be administered through clothing

• One caregiver helps the child remain still

• A second caregiver administers the medication

• Keep the EpiPen® out of site until it is time for

administration

• Offer a quick explanation of what you are about to do

45


How to Administer EpiPen®, continued

• Check the Five Rights

• Remove EpiPen® from the plastic tube

• Grasp the EpiPen® with your dominate hand, orange

tip facing down

**DO NOT TOUCH THE ORANGE TIP

• Remove the blue safety-release cap

• Locate the outer thigh

• Hold the medication at a 90° angle

46


Call 911 after Administering Emergency

Medications

• Anaphylaxis is a medical emergency

• Severity of symptoms can quickly progress to a

life-threatening situation

• Follow authorized prescriber’s order on the


47


Call 911

• Confirm that someone has called 911

o Request a paramedic and inform them that

EpiPen® has been given

• EpiPen® only lasts approximately 15 minutes

• Additional medical attention is always required so the

child is ALWAYS transported to the nearest hospital

• Give the used EpiPen® to the emergency responder

48


EpiPen® is Child Specific

• EpiPen® is child specific and must be provided by

the child’s parents for use at the center

• It may only be administered with proper authorization

for the indicated child

• It MAY NOT be administered to another child even

in an emergency

49


EpiPen® Storage

• Store unlocked, in a safe manner, inaccessible to

children

• In an area that will allow for quick access in an

emergency

• In a dark, unrefrigerated area, between 56-86

degrees

• Must accompany the child wherever the child goes

(in a staff backpack or insulated cooler)

50

Resources

American Academy of Asthma and Immunology

http://www.aaaai.org/conditions-and-

treatments/allergies.aspx

Food Allergy & Anaphylaxis Network

http://www.foodallergy.org

Vermont Department of Health

http://healthvermont.gov/local/school/documents/SP03_

allergies.pdf

51

http://www.aaaai.org/conditions-and-treatments/allergies.aspx





http://www.foodallergy.org




Thanks to:

Healthy Child Care Connecticut

Medication Administration Training Program

Massachusetts Medication Administration

in Child Care Curriculum

Lori S. Yu MSN, APRN, CPNP

Child Care Health Consultant

Angela Crowley, PhD, APRN, PNP-BC, FAAN

Associate Professor

Yale University School of Nursing

52


Problem Solving

• Medication Errors

• Side Effects

• Medication Incidents

• Trouble shooting and documentation

• Field Trips

• Handling requests


Introduction: Common Errors

in Medication Administration

7,000 children per year require emergency department

visits for medication problems

• Common errors – Took medication twice

– Wrong medication

– Incorrect dose

– Missed dose

• Common causes – Not understanding medication label

– Not understanding how to give medication

– Poor communication between parents/guardians and health care

professional

– Child Care Survey-missed doses


Most Common Medication Errors

• Errors are most commonly made with OTC analgesics,

which is the class of medication which includes

Tylenol® (acetaminophen) and Motrin® (ibuprofen)

• Reasons for errors include:

– These medications are given frequently

– There are many different concentrations (infant drops,

children’s liquids, etc)

– They are often mixed with other medications in cough and

cold preparations

– Dosing charts are unique to the type and form of the

medication


Communication and Care

• Preventing errors begins with

good communication on

drop-off and pick-up


What is a Medication Error?

• Giving the medication to the wrong child

• Giving the wrong medication

• Giving the wrong dose

• Giving the medication at the wrong time

• Giving the medication by the wrong route

…any of the “5 Rights” gone wrong…


Preventing Medication Errors

• Look at the pattern of errors

• Make changes based on the patterns seen to prevent

further errors of that type – A common error is forgetting to give a dose of medication

– Set an alarm to remind you that it is time to administer a

medication

• Can you think of other ways to prevent errors?


Side Effects of Medication

• A secondary and usually adverse effect of taking a medication

• Common side effects include: – Upset stomach

– Diarrhea or loose stools

– Dry mouth

– Drowsiness

– Change in activity or mood

– Dizziness

– Flushing, sweating

– Rashes

– Rapid heartbeat

– Nausea


Side Effects of Medication, continued

• Effects of medication can vary from child to child

– The same antihistamine (diphenhydramine/Benadryl®) can

make one child sleepy while another becomes jittery and

hyperactive

• Side effects that could be normal for 1 medication

might be abnormal for another

– Fast heart rate is expected for albuterol, an asthma

medication, but not for a fever reducing medication


Sources of Information About Medication Side Effects

• Package inserts or labels

• Information from pharmacy

• Information from the prescribing health care

professional

• The child’s health assessment or care plan completed

by the health care professional

• Reliable reference materials like the PDR (Physician’s

Desk Reference)

• www.consumermedsafety.org


Adverse Effects or Allergic Reactions to Medication

Adverse Effect

• Any undesirable experience associated with the use of

a medical product in a patient

• Examples of adverse reactions:

o fainting

o double vision

o vomiting

o seizures

o long-term effects such as liver damage

• Source: FDA MedWatch site (www.fda.gov)


Observation

Young children can’t always verbalize side effects,

adverse effects, or allergic reactions, so careful

observation is essential


What To Do for Medication Errors, Adverse Effects, or Allergic Reactions

Always:

• If the child is in distress, call 911

• Notify the center director (if this is a serious error, do not delay the 911

call)

• Notify parent or guardian

• Fill out a Medication Incident Report

Many times you will:

• Call Poison Control

• Contact the health care professional

• Check with the Child Care Health Consultant, if available

• Notify state Bureau of Licensing


When Should You Call 911?

• When you see signs of distress

• When there is a loss of (or change in) consciousness

• Blue color or difficulty breathing

• Difficulty swallowing

• Swelling of lips, tongue, or face, or drooling

• Seizure activity

• Rapidly spreading rash or hives

• Impaired speech or mobility

• Getting worse quickly

• When in doubt


When Should You Call Poison Control? 1-800-222-1222

• When medication is given to the wrong child

• When the wrong medication is given to a child

• When the wrong dose is given (overdose)

• When a medication is given by the wrong route

• When a medication is given at the wrong time (and it

results in an extra dose)

The AAP no longer recommends that syrup of ipecac be used


If You Call Poison Control

Have this information ready:

• The medication container

• Child’s Medication Administration Packet

• Child’s Emergency Contact Form

• Child’s current weight or the most recent weight known

( recording a child’s weight on the medication log is a

good way to assure that it is available for any reason)


Medication Incidents (that aren’t errors…)

• Child refusal

• Spit out doses

• Vomited doses

• Spilled medication


What To Do for Medication Incidents?

Always:

• Notify the center director

• Notify parent/guardian

• Fill out a Medication Incident Report

• Develop and document a follow-up plan

Many times (depending on the situation):

• Contact the health care professional and Child Care Health Consultant

Never:

• Repeat a dose that the child does not keep down without

specific instructions from a health care professional


Medication Incident Report

• To be completed by the

person who administered the

medication or his or her

supervisor


Documentation of an Error or Incident

• Make notation on the Medication Log for that dose

• Complete Medication Incident Report

• Follow up according to child care facility policy


Scenario: Nick

• You gave Nick his dose of amoxicillin at noon and

recorded it. At 12:30, you note that Nick is scratching

his arms and he is developing a rash on his arms. He

is happy and playful and is not having any breathing

difficulties. You notify his parent who calls his health

care professional. Nick is picked up at 1:00 and is

brought to the health care professional’s office where

he receives Benadryl®. His amoxicillin is discontinued

and he is given a new antibiotic.


Other Resources

• Child Care Health Consultants

• National Resource Center for Health and Safety in

Child Care

– Caring for Our Children Standards

– 1-800-598-kids

– http://nrckids.org

• Local pharmacist

• Child’s health care professional

• Local children’s hospitals

• Other health educators


Transportation Provided by the Child Care Facility and Field Trips

• A staff person authorized to administer medication should be present

when supervising a child outside of the child care facility grounds

• Medication should be properly secured and labeled

• The proper temperature and conditions for the medication should be

maintained

• Copies of emergency contact information and the child’s medical forms

should be carried

• The dose of medication given outside of the facility must be properly

logged, and any side effects should be noted

• Hand hygiene must be maintained

• Emergency contact methods (such as a cell phone) must be available

• Obtain information about the closest emergency room on route


Provider Refusal

• There may be an occasion when you must refuse to give

medication because: – Special training is needed before administering medication

– Required authorizations or other documentation is lacking

– Parent makes inappropriate request

– It is against facility policy


Inappropriate Requests

• Non-essential medication

• Medication not authorized by a health care professional

• Off-label use

• Cough and cold medications for young children


Child Care Provider Refusal Options

• Have your medication administration policy available – The parent should have signed a copy of it upon enrollment

• Take a problem-solving, child-centered approach

• Seek alternative plans like having a nurse or parent come to

administer the medication

• See if medication timing can be changed to avoid a dose

during hours of care

• Consider obtaining special staff training, if appropriate


Responding to Parents/Guardians

“I do understand, but for the safety of your child and

the other children in our setting…”

“I am sorry, but according to our policy…”


What to Do?

• Call your supervisor

• Ask the parent to make alternative arrangements

• Record the situation and document the response


Wrap Up

• Post-test

• Additional Resources

• Certificate of Attendance


Sources

• Colorado: Guidelines for Medication Administration: An Instructional

Program for Training Unlicensed Personnel to Give Medication in Out-of-

Home Child Care, Schools, and Camp Settings, Fifth Edition, 2008,

developed by Healthy Child Care Colorado

• New Jersey: Medication Administration in Child Care developed by Healthy

Child Care New Jersey

• North Carolina: Medication Administration in Child Care in North Carolina

developed by the Quality Enhancement Project for Infants and Toddlers, with

funding from the NC Division of Child Development to the Department of

Maternal and Child Health at the University of North Carolina at Chapel Hill

• West Virginia: Medication Administration: An Instructional Program for

Teaching Non-Medical Personnel to Give Medication in Child Care Centers

in West Virginia developed by Healthy Child Care West Virginia and the West

Virginia Department of Health and Human Services


Congratulations!

“The level of civilization attained by any society will be

determined by the attention it has paid to the welfare

of its children.”

B. Andrews, 1968,

The Children’s Bill of Rights

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